Respiratory System Flashcards
What is the BTS/SIGN guidelines for the management of asthma?
SABA used in all stages as reliever
Step 1: Low dose ICS
Step 2: Add LABA (with low-dose ICS)
Step 3: Increase dose of ICS, or add LTRA, LAMA or theophylline
Step 4: High dose ICS, or add another drug
Step 5: oral steroid
When should step up therapy be considered in asthmatics?
If using their inhaler >3 times a week
If having night time symptoms at least ONCE a week
If they have had an asthma attack within the last 2 years
What are the NICE guidelines for the management of asthma?
SABA used in all stages as reliever
Step 1: Add low dose ICS
Step 2: Offer LTRA + ICS
Step 3: Add LABA (alongside ICS + LTRA)
Step 4; Switch to MART therapy
Step 5: Increase ICS dose
What are some side effects of B2 agonists?
Arrhythmia
Hypokalaemia
Palpitations
Tremor
Hyperglycaemia
How often are inhaled LABAs given in a day?
Twice a day
What is the maximum number of salbutamol puffs a person take in a day?
Max. 1-2 puffs four times a day
Which brands of inhalers are only used for >18 years old?
Fostair
Duoresp Spiromax
Symbicort
What are the active ingredients in Fostair, Duoresp Spiromax, and Symbicort?
Fostair: formoterol + beclometasone
Duoresp Spiromax: budesonide + formoterol
Symbicort: budesonide + formoterol
Which 2 brands of beclometasone inhalers should never be interchangeable, and why?
Qvar and Clenil
Qvar is x2 as potent as clenil due to extra fine particles, so these cannot be interchangeable
(Fostair also has extra fine particles like Qvar)
What is the max. expiry date for Fostair after dispensing?
3 months.
What should always be given to patients taking high ICS doses?
A steroid card
What specific side effect should patients be warned about when dispensing montelukast?
Report signs of neuropsychiatric reactions e.g. speech impairment, obsessive disorders, etc
Which LTRA antagonist must be reported for signs of liver toxicity?
Zafirlukast
What type of drug is theophylline?
It is a xanthine bronchodilator
What is the therapeutic range of theophylline, and when is a sample taken?
10-20mg/L, sample is taken 4-6h after dose given
What are the signs of theophylline toxicity?
Remember FAST and SICK
Vomiting/GI side effects
Tachycardia
Arrhythmia, convulsions, hypokalaemia
When should plasma theophylline levels be measured? What if it is an MR prep?
5 days after starting dose, and 3 days after any dose changes
If prep is MR, then sample should be taken 4-6h after first dose
What should you do to the dose of theophylline is the patient is a smoker?
Theophylline dose must be increased because smoking is enzyme inducing (which can lower theophylline levels)
Which specific mineral must be monitored if a patient is taking theophylline alongside a SABA?
Potassium levels
Which specific enzyme inhibitor can potentiate convulsions if given with theophylline?
Quinolones (e.g. ciprofloxaci), because it can lower the seizure threshold level
What is the max number of puffs which can be taken in an acute asthma attack?
10 puffs in 10 minutes
What is given during an acute asthma attack in hospital?
High dose SABA via oxygen-driven nebuliser (or SAMA)
O2 to maintain levels 94-98%
Oral prednisolone, or IV 200mg hydrocortisone
How long is prednisolone given for an acute asthma attack for adults and children <12years?
Adult: 5 days (40-50mg OD)
Child <12yrs: 3 days
What do you increase the risk of if a COPD patient is taking a SAMA + LAMA together?
Anticholinergic side effects
